(It’s Wednesday and that usually means we Explore More. But I have decided to move that feature to Fridays, so you get a plain-Jane post from me today.)

In my posts about Why I Eat the Way I Do I said that the acne issue deserved more space than I could spare then, and that I would write a subsequent post devoted solely to my acne journey.

It’s not a post I’ve particularly relished writing. Acne, though often seen as a “normal” occurrence, can be excruciatingly painful both physically and emotionally.

Just because something is common and prevalent, however, does not make it “normal” and I would argue that by accepting this notion that acne is normal, we have done ourselves and our skin a great disservice.

But before I get to the end and my conclusions, I need to start at the beginning.

I was twelve and my hairdresser was washing my hair when she pointed to the small lesions on my forehead and told my mother she should do something about those. My mom, who has maybe had a single pimple in her entire life, made sure I saw a dermatologist as soon as the teen hormones started to wreak their havoc on my face.

It was the late 1980s and the treatment du jour included rounds of antibiotics, extractions, and a spray of liquid nitrogen coupled with prescriptions for topical antibiotics and an injunction against picking.

Somewhere in the recesses of my soul, I knew that this regimen wouldn’t work for me. But I did as the MD ordered.

When I was a senior in high school, I began to experience heart palpitations. I complained to my parents and my dad, also an MD, arranged for me to have an EKG in his office, largely to silence my fears. It came back normal and I wasn’t concerned anymore.

Fast forward a few years to my sophomore year of college. My lesions had become nodular, cystic, ever-present little boogers. Sometimes it hurt to lay my head on the pillow at night. My internist decided that they had to be hormonal, so she put me on oral contraceptives.

So now I am on powerful, artificial hormones for my skin.

And they didn’t work either. The cysts persisted.

Meanwhile, it should go without saying that I am trying every single topical solution ever offered. The idea of falling to sleep without washing my face, toning and moisturizing would never have occurred to me, not even on the rowdiest of evenings. My skin was cystic and lesion-filled even with the best attention. I couldn’t neglect it for even one night.

I got engaged in June of 1997. I was a law student at the time and all I wanted in the world was clear skin for my wedding. I found a doctor in Austin who would prescribe for me what was considered the gold standard – Accutane. I arranged to have weekly blood tests to monitor my liver enzymes and began on a small initial dose.

If you have ever known – or yourself been – an Accutane user, you know it is intense stuff. I remember sitting in class, peeling skin off my face in long sheets. My nails became brittle. I couldn’t wear makeup. The inside of my nose cracked and my lips felt like a desert. I carried a tub of Aquaphor around with me everywhere.

And I was angry.

That first night, I remember literally throwing my shoes against the wall. (They happened to be the things within my grasp.)

“This is insane,” I thought to myself. “I don’t even know why I’m so angry.”

Then, a mere six months after I stopped the Accutane, the cysts returned.

After experiencing the rage and physical symptoms that I did on Accutane, I vowed I would never take it again. (As I understand it, it is not unusual for patients to require more than one course of treatment.) Given that I got a mere six months respite, I refused to again take the chances with my health that I did while on that powerful drug.

Meanwhile, I had determined that there had to be more going on with my acne than simply my having “bad skin.” I figured hormones were involved somehow. On the advice of a woman who specialized in advocating for patients, I saw an endocrinologist. He prescribed spironolactone, and explained that it would help my body clear androgens that I wasn’t able to process that may be causing my cysts.

“Spiro” as it is often called, helped my cysts a bit and confirmed for me that although I was not going through puberty, my hormones could still be affecting my skin and causing my (now “adult”) acne.

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4 Responses to “Acne. Ugh.”

I have my first pimple forever memorialized in my 5th grade picture (along with some awesome stray hair “wings” popping out of the side my head). That lone zit on my chin was just the beginning of a life long battle with acne and extreme oiliness.

Acne (at any age) can deeply affect one’s self esteem. Only until I was in my mid-twenties and my breakouts subsided somewhat did I have any semblance of confidence in my appearance.

Well let me just clarify that my “wings” were more like significant amounts of wisps of hair that were not contained from my ponytail and were poking out from either side of my head. My conservative Korean mother would have never allowed me to experience the awesome thrill of full on feathered hair. This is why, that by the 8th grade, I had hair down to my derriere a la Crystal Gayle.

In regards to my battle with acne, I’ve found that Retin-A (0.05%) is my best bet at addressing my clogged pores and early signs of aging. Let me preface this by saying I am extremely oily. I’m not talking about a gentle glow, but a full on greasiness that necessitates several sheets of blotting paper throughout the day. I even have a bit of oil breakthrough my makeup before I even leave the house in the morning.

My dermatologist has mentioned how oily skin tends to show signs of aging a bit later. I try to remember this when my I look at my nose and chin and see how quickly clogged my large pores can become.

I’m also a fan of salicylic peels. Whilst I’ll get one or two cystic pimples once a month (nothing like having PMS and sore bumps on your chin all at the same time), currently my acne is in direct relation to how easily congested my skin can become.

As a teenager, the severity of my acne did not qualify me for Accutane. I had some cysts, but mostly papules and pustules (otherwise know as acne vulgaris). I received the standard treatment of oral and topical antibiotics. The army doctors also threw in some Retin-A for good measure once I started college. I’m not sure what percentage they gave me, but it left me raw and scaly. Nothing like having little sheets of skin pop up around your mouth when you open your mouth too wide to eat a sandwich. Even better when you don’t realize that you have these flaps fluttering in the wind as you walk around campus.

In my twenties I was prescribed Ortho Tri Cylen which, for me, helped a bit as well. I also ditched the Retin A and used a topical cream with azelaic acid. Small improvements that lead me to fairly clear skin by age 25.

Let me emphasize that my skin is not perfect, but it’s as good as it’s going to get without going cuckoo crazy with the severity of the topical peels I’m willing to use. My current formulation of Retin-A agrees with my skin if I use it every other day. I’m content with the realization that my skin could look much worse.

After reading your other post, I’m compelled to mention that I do consume dairy. On the sliding scale of healthy eating, I’d give myself a five. I eat quinoa, love brussel sprouts, and will incorporate ground chia seeds into my oatmeal. I’m willing to give a variety of foods a try, though seafood and fish are a major no go. I loved a lot of my mother’s cooking, but the smell of a spicy mackerel stew or simmering blue crabs is forever ingrained in my olfactory memory. And not in a good way.

But I’m fan of sweets (yes, I know how bad white sugar is for the skin and overall well being) and caffeine. I do not get a lot of sleep and there are days that I subsist of several cups of coffee, cake or some sort of other sweet treat, and the sheer will to get everything done that I feel is necessary. It isn’t all of the time, but it happens more than I care to admit.

When I nourish my body properly and get at least seven hours of sleep, the appearance of my skin does improve . I don’t necessarily see a reduction of breakouts, more of a “gee, you look well rested and healthy”. I supplement my diet with Whole Foods 365 multi vitamin for women and a triglyceride omega soft gel (I hold my breath when I open the bottle and try to swallow it as quickly as possible).

I’ve never been tested for allergies to dairy or gluten. I have confidence that, yes, I would feel an increase in energy and overall well being if I opted to eliminate these foods. I am, however, not willing to do so at this time. The time may come when I feel compelled to do so, but until then I will continue to make my dark chocolate cake, filled with whipped dark chocolate ganache, and chocolate cream cheese frosting.

But I digress. Hope my experience will help enlighten other’s who’s experience with acne may not be directly related to food allergies or hormones.

Sometimes I WISH my skin were actually oily. Because it really isn’t. I mean, it went through that teen-oiliness, of course. But all in all, it actually tends to be drier. Because of that, a lot of the topicals leave me still cystic AND sporting scaly, dry, red skin. I, too, have enjoyed those little flaps of skin you described so well!

On the other hand, I suppose not having oily skin has made me more convinced that the origin of the problem was within my body and in my gut. So it has led me to look into other issues. I just wish I didn’t have to.